BCBS infertility coverage for feds
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Anonymous
| I am surprised not to see a ton of info/posts about this on here. It seems like a huge step forward, since it will cover $25,000 a year when previously feds had basically no IVF coverage. Am I missing something-is it not as good as it seems? Or are there just not many feds on here who will be able to take advantage? My husband and I are planning to switch to BCBS for next year to take our shot at IVF, but the monthly premiums are much higher than we currently have with Kaiser, so now I am second guessing and worried I am misunderstanding the BCBS coverage or something. Appreciate any insight!! |
Anonymous
| There is always a catch! I wouldn't be surprised if it barely covers 1 round. That's still better than 0 I guess. |
Anonymous
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I think there are still a lot of unknowns at the moment. Once upon a time there were fed insurance that covered IVF and Shady Grove had a negotiated rate. There are many of us wondering (and hoping!) SG will have a negotiated rate with BCBS for next year, but no one seems to know: https://www.dcurbanmom.com/jforum/posts/list/1172719.page
Even with the unknowns, my husband and I decided to switch to BCBS for next year. Our premiums will double, so I feel you. |
Anonymous
| It depends on how the benefit is structured. I did IVF under the long-ago MD-IPA plan and the insurance rate was about $5000 for the IVF cycle, while meds were fully covered. There were lots of things that were not covered though, such as embryo freezing and PGS screening. |
Anonymous
| I think the BCBS fed plan would definitely make sense for IVF depending on your situation. It has the increase in premiums over other FEHB plans and has 15% copay (does require preauthorization), but compared to our out of pocket expenses for our last IVF round (~10k IVF, ~5k FET, ~8k meds) I think it would be a considerable savings. |
Anonymous
| Has anyone started treatment under this BCBS plan yet? How much is coverage? Was it difficult to obtain pre-authorization for treatment and/or meds? |
Anonymous
| We started last year and did the egg retrieval with no coverage. But our preapproval for the transfer came through so that will be covered. Meds are not, and embryo thawing is not, but weirdly the SGF counselor told us no insurance covers thawing. |
Anonymous
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About to start cycle with Dominion. Are not doing PGT testing so at this time we only need to pay $850 to Dominion and will need to pay $650 should we get an embryo we need to freeze. BCBS rejected our application initially, but Dominion said other people are not having this problem and after about two weeks were approved. We at this point have a diagnosis beyond unexplained infertility.
We just have ordered the drugs, which will be a $125 copay for 90 days, which is going to cover all the medication you need and basically max out at about $500. Yes its a huge savings - we spent about $50k on two rounds last year. |
Anonymous
Can I ask how long your preapproval took? I have been...less than impressed with our financial counselor and we have been back and forth with her for nearly two months (am now trying to deal directly with the insurance company, too) and wondering if I should push to move to a new counselor or our timeline is actually standard. |
Anonymous
10 days? SGF submitted it and warned us it could take 15 days but it definitely came back faster than that. |
Anonymous
Thanks! Ours finally got approved after 14 days but that only happened because we called BCBS repeatedly and finally got them to expedite it. We have been told meds are covered (with co-pays being either $65 or $85) and that all procedures are approved except for cryopreservation, embryo storage, and genetic testing (PGT-A). I'm a bit irritated about the genetic testing not being covered, as I recall we are required to do it to move forward -- but I think that's an SGF requirement due to my age. I have to pay a $5200 deposit before moving forward. So, not totally covered by any means but WAY better than without coverage, obviously. Hope that helps! |
Anonymous
| I’m also at SGF and haven’t been impressed with my financial counselor. I had to follow up repeatedly to get my insurance info updated in the system. They took over 2 weeks to verify my benefits. What happens next? Do I need to follow up and ask them to submit pre approval to BCBS? Or will they automatically submit? |
Anonymous
I would definitely send a note to your financial counselor confirming they have submitted for authorization -- mine had not automatically done this (very irritating). There is apparently some questionnaire SGF fills out--not their finance department, a different department--which is then sent to the insurance company for the preauthorization, and I followed up two weeks after I was told they were working on it and it still hadn't been sent. A supervisor eventually had to get involved to get it expedited (also very irritating). |
Anonymous
| Update on meds cost - my total copay for all my meds was $260 ($65 copay for four different meds) vs paying about $6k for these drugs out of pocket for one cycle. Yes, this plan is a no brainer on meds alone. |
Anonymous
Are the medicine expenses counted towards the $25,000 total infertility coverage? CVS specialy charges four times of the regular price at other pharmacies. Shouldn't we buy the drugs out of network and only use $25,000 toward IVF procedures, if expecting mutiple rounds of IVF? |